Digging Deeper: The Story Behind the New Uninsurance Numbers

We were so prepared. In the days leading up to Tuesday’s Census Bureau release of 2007 health coverage data, we formatted spreadsheets to analyze the new numbers. We drafted potential language for our press release. We listened to the forecasts of health economists, predicting that the number of uninsured Americans would continue its upward trend this year.

And then we got the data. Surprise! The number of uninsured Americans did not increase, as expected. Instead, there was a modest decline in the uninsured, from 47 million in 2006 to 45.7 million in 2007. Rates of uninsurance decreased for women specifically; in 2007, 281,000 fewer women (ages 18 and older) were uninsured, and the proportion of uninsured women dropped slightly from 15.1 to 14.8 percent. Though women of color are still considerably more likely to lack insurance than their white counterparts, rates of uninsurance went down for women across race categories with one exception – more Asian, Native Hawaiian, or Pacific Islander women were uninsured in 2007 than in 2006. Uninsurance among Hispanic women fell by 2 percentage points – the largest decline of all.

So, what gives? How can the number of uninsured Americans be going down when we know that a) more and more people are skipping necessary care because they can’t afford it, b) the cost of health insurance premiums is growing much faster than wages, and c) fewer small and medium-sized businesses are offering health coverage to their workers each year?

And the gold star goes to…public health insurance! If not for significant increases in coverage under government-sponsored health plans, the number of uninsured people would have undoubtedly risen in 2007, just as it did in all those years past. Public health insurance programs like Medicare, Medicaid, and the State Children’s Health Insurance Program (SCHIP) covered an additional 905,000 women, 924,000 men, and 932,000 children in 2007. We can think of two main reasons for this – 1) people are becoming poorer and thus newly eligible for public health insurance and 2) states are extending their public programs to cover those not previously eligible. Both factors play a role here. In fact, poverty rates did increase for certain groups last year, and state governments have also taken major steps lately to expand public programs to cover the uninsured. Between July of 2006 and January of 2008, nearly two-thirds of the states increased access to health coverage for lower-income families. In Massachusetts alone, over 300,000 more residents were covered by public health insurance in 2007 than in 2006.

Private coverage, meanwhile, continued its steady downward spiral. For the seventh year in a row, the proportion of women covered by private health insurance declined, from 69.2 percent in 2006 to 68.7 percent in 2007. The percentage of women with job-based health insurance—the primary form of private coverage—fell slightly (these trends mirror those for Americans overall).

Simply put, this is not a story about things getting better in our health care system. This is a story about public health insurance programs stepping in to save the day. And considering how vulnerable these programs are during tough economic times, this story probably won’t end well. Public programs typically show up on the chopping block during economic slowdowns, and considering the fiscal troubles states are reporting, we worry about what the Census release will show next year. As their budgets fall on tough times, states will cut back on their public coverage programs (they’ve already started). Pared down, public programs won’t be able to offset the continuous decline in private coverage, and uninsurance numbers will likely go up again.

Fewer uninsured women—it does sound like a good thing. But what these numbers really show is that we need a solution to the health care crisis. Seventeen million women in this country—more than one in seven—still don’t have any coverage at all. Moreover, public health insurance programs are the only reason that more women had coverage in 2007 than in the previous year. As we pursue guaranteed high-quality and affordable health insurance for all, we must protect and expand the public programs that play an increasingly important role in our health system – they should serve as strong foundations for national health reform. But our solution must also make it easier for employers to offer—and for women and their families to purchase—job-based health coverage. Don’t be fooled by the positive news on reductions in the uninsured. We’ve still got a long way to go!